Driscoll Model of Reflection in Nursing: What, So What, Now What
A difficult shift rarely ends when the handover is complete. A comment from a patient, a missed cue, a tense conversation with a relative, or a clinical decision made under pressure can stay in a nurse’s mind long after leaving the ward. Reflection gives that experience somewhere useful to go.
The Driscoll Model of Reflection in nursing offers a simple, memorable structure for learning from practice. Built around three questions, What? So what? Now what?, it helps nurses move from description to understanding, then from understanding to better action.
Its strength is its simplicity. A nurse does not need a long template or academic language to use it well. The model works after a complex incident, a routine interaction, a student placement experience, or a moment that felt emotionally challenging.
Why reflective practice matters in nursing
Nursing involves constant judgement. Some decisions are clinical, such as escalating a deteriorating patient. Others are interpersonal, such as explaining care to someone who is frightened or frustrated. Many happen quickly, with incomplete information.
Reflection turns these experiences into learning. It helps nurses:
recognise what went well
identify gaps in knowledge or confidence
understand emotional responses
improve communication
prepare for similar situations
connect practice with professional standards
Reflective practice also supports safer care. When nurses review events carefully, they are more likely to notice patterns. For example, a nurse may realise they delay asking for help when busy, or that they need a clearer method for prioritising tasks during medication rounds.
The Driscoll model is often used in nursing education and clinical supervision because it keeps reflection focused. It avoids vague thinking such as “that shift was stressful” and encourages more useful questions, such as “What made it stressful, what did I learn, and what will I do differently next time?”
The three stages of the Driscoll model
The model is based on three direct questions. Each one has a different purpose.
Stage | Main purpose | Key question |
What? | Describe the experience clearly | What happened? |
So what? | Analyse meaning and learning | Why did it matter? |
Now what? | Plan future improvement | What will I do next? |
Used together, these questions stop reflection from becoming either a diary entry or a self-critical exercise. The aim is not to judge the nurse harshly. The aim is to learn honestly.
Use the What stage to describe the experience
The first stage asks for a clear description of what happened. This sounds simple, but it is often where reflection goes wrong. If the description is too vague, the later analysis becomes weak. If it includes blame or assumptions too early, the reflection may become defensive.
The What? stage should focus on observable details.
Useful prompts include:
What happened?
Where did it happen?
Who was involved?
What was my role?
What actions did I take?
What did other people do?
What was the outcome?
What did I notice at the time?
For example, a nurse might write:
During an early shift on a medical ward, I cared for an older patient admitted with a chest infection. The patient became more short of breath after breakfast. I checked their observations and noticed their respiratory rate had increased. I informed the nurse in charge and contacted the medical team. Oxygen therapy was reviewed, and the patient was later transferred for closer monitoring.
This description avoids dramatic language. It does not jump straight to conclusions. It gives enough detail for meaningful analysis.
Practical nursing example
Imagine a newly qualified nurse looking after four patients. One patient asks for pain relief, another needs discharge paperwork, and a third has family members asking questions. During this period, the nurse gives pain relief later than planned.
A useful What? reflection might include:
the time pressures during the shift
the patient’s reported pain score
what task took priority
when the medication was due and when it was given
whether the delay was discussed with the patient
whether support was requested
A less useful reflection would say, “I had a bad shift and did not manage my time.” That may be true, but it is too broad to teach much.
Use the So what stage to analyse significance and learning
The second stage is where the reflection becomes deeper. So what? asks why the experience mattered. It explores feelings, assumptions, choices, knowledge, communication, teamwork, and patient impact.
This stage can feel uncomfortable because it asks the nurse to look beneath the surface. Yet it is also where the most valuable learning happens.
Useful prompts include:
How did I feel during and after the event?
Why did I respond in that way?
What knowledge helped me?
What knowledge did I lack?
What went well?
What could have gone better?
How did the situation affect the patient?
How did communication influence the outcome?
What professional values were involved?
What does this reveal about my practice?
The goal is balanced analysis. Good reflection includes strengths as well as areas for development.
Practical nursing example
Take the delayed pain relief scenario. The So what? stage might explore several points.
The nurse may realise they prioritised discharge paperwork because another professional was waiting. On reflection, the patient’s pain should have been reassessed sooner. The nurse may also recognise that they did not explain the delay to the patient, which may have reduced trust.
At the same time, the nurse might identify strengths. They remained calm, completed safety checks before administering medication, and documented the medicine correctly. The issue was not a lack of care. It was prioritisation and communication under pressure.
A strong reflection might say:
I felt pulled between several tasks and worried about slowing the team down. I now recognise that I allowed the visible pressure from colleagues to shape my priorities. The patient’s pain was immediate and should have been reviewed earlier. I also missed a chance to communicate clearly with the patient, which may have made them feel ignored.
This analysis is specific. It links feeling, behaviour, patient experience, and future learning.
Avoid turning analysis into self-blame
Reflective practice should not become a list of personal failings. Nursing is complex, and many events are shaped by staffing levels, ward activity, acuity, communication systems, and team culture.
A fair So what? stage asks two questions at once:
What was within my control?
My prioritisation, communication, escalation, documentation, preparation, knowledge
What wider factors influenced the situation?
Workload, interruptions, skill mix, unclear processes, delayed responses from others
This balanced view supports professional growth without ignoring real workplace pressures.
Use the Now what stage to plan future action
The third stage turns reflection into improvement. Without Now what?, reflection can stay as thought rather than change.
This stage asks what the nurse will do next time. The plan should be realistic and specific. “I will communicate better” is a good intention, but it is not enough. “I will update the patient if pain relief is delayed and ask a colleague for support when urgent tasks compete” is stronger.
Useful prompts include:
What will I do differently next time?
What will I continue doing?
What knowledge or skill do I need to develop?
Who can support my learning?
What policy, guideline, or evidence should I review?
How will I know I have improved?
What can I discuss in supervision or with my assessor?
Practical nursing example
For the delayed pain relief scenario, the Now what? plan might include:
Use a quick written priority list at the start of each shift.
Reassess pain within the expected time frame after analgesia.
Tell patients when there is a delay and explain what is happening.
Ask the nurse in charge for help when several urgent needs arise.
Review local pain management guidance.
Discuss prioritisation strategies with a preceptor.
This is practical. It gives the nurse behaviours to try, not just ideas to remember.
Applying the model in everyday nursing practice
The Driscoll model can be used in many parts of nursing, from student learning to senior clinical practice. It works best when used soon after an event, while details are still fresh.
After a challenging patient interaction
A patient may become angry about waiting times, medication changes, or discharge plans. Reflection can help the nurse separate the patient’s emotion from their own response.
What?
The patient raised their voice during a discussion about discharge medication. I explained the prescription but felt rushed because another patient needed assistance.
So what?
I felt defensive and shortened the conversation. The patient may have needed more time to understand the change. My body language may have suggested impatience.
Now what?
I will pause before responding, acknowledge the concern, and check understanding using a calm phrase such as, “I can see this feels worrying. Let us go through it step by step.”
After a medication near miss
A near miss can be unsettling, but it can also prevent future harm if reviewed properly.
What?
I almost selected the wrong dose because two medicines had similar packaging. I noticed the error during the checking process.
So what?
The checking process worked, which protected the patient. I also recognised that I was distracted by interruptions during preparation.
Now what?
I will reduce interruptions where possible, follow local medicines policy, and raise the packaging similarity with the nurse in charge or safety reporting system.
After successful escalation
Reflection is not only for mistakes. It also helps nurses understand good practice.
What?
I noticed a patient’s condition was worsening and escalated using a structured communication tool.
So what?
Early recognition and clear communication helped the team respond quickly. I felt more confident because I had objective observations ready.
Now what?
I will keep using structured escalation and encourage students to gather clear evidence before contacting senior staff.
During academic study or placement
Student nurses often use reflective models in assignments and portfolios. Reflection supports the link between theory and practice, especially when discussing clinical judgement, communication, ethics, or professional development. Some students compare academic guidance, supervisor feedback, and nursing thesis writing services when trying to understand how reflective writing differs from ordinary description.
Tips for writing a strong Driscoll reflection
Good reflective writing is clear, honest, and focused. It does not need dramatic language. It needs evidence of learning.
Use these tips to strengthen the reflection:
Choose one clear incident
A focused moment is easier to analyse than an entire shift.
Protect confidentiality
Avoid patient names, exact dates of birth, hospital numbers, or details that could identify someone.
Write soon after the event
Brief notes taken early can help preserve accuracy.
Balance strengths and improvements
Reflection should recognise safe and effective practice as well as learning needs.
Link thoughts to action
The final stage should show what will change in future practice.
Use professional language
Honest does not mean informal or careless. Keep the tone respectful.
Discuss learning with others
A mentor, preceptor, practice assessor, or clinical supervisor can help test assumptions and suggest next steps.
Common mistakes to avoid
Some reflections look complete on the page but do not lead to much learning. These are common traps.
Describing too much and analysing too little
A long timeline of events is not enough. The So what? section should explain meaning, not repeat the story.
Writing what sounds good rather than what was true
Reflection works only when it is honest. If a nurse felt anxious, unsure, frustrated, or proud, those feelings can be explored professionally.
Making the action plan too vague
Plans such as “be more organised” or “improve confidence” are hard to measure. A better plan names the behaviour, support, and next opportunity to practise.
Ignoring the patient’s experience
Nursing reflection should consider how the event may have felt for the patient or family. This keeps learning centred on care, dignity, and safety.
FAQ
What is the Driscoll reflective model?
It is a simple reflective framework based on three questions: What? So what? Now what? It helps nurses describe an experience, analyse its meaning, and plan future improvement.
Why is the Driscoll model useful for nurses?
It is easy to remember and practical during busy clinical practice. It supports learning from real events, including communication challenges, clinical decisions, near misses, and positive examples of care.
Can student nurses use the Driscoll model in assignments?
Yes. Student nurses often use it for reflective essays, placement portfolios, and discussions with assessors. They should always follow their university guidance and protect patient confidentiality.
Is reflection only needed after something goes wrong?
No. Reflection is also useful after good practice. Reviewing what worked well helps nurses repeat safe, compassionate, and effective care.
How long should a reflective account be?
It depends on the purpose. A short practice note may be a few paragraphs. An academic reflection may need more detail, references, and links to professional standards.
A simple model for thoughtful nursing practice
The Driscoll model works because it asks the questions nurses need after meaningful clinical experiences.
What happened?
So what did it mean?
Now what will change?
Used well, it turns everyday practice into professional learning. It helps nurses notice their decisions, understand their reactions, and take clearer action next time. Reflection does not need to be perfect to be valuable. It needs to be honest, specific, and connected to better care.
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